ANTERIOR TEETH

Tooth Pulp Chamber Number of Roots Entrance Point Access Cavity Shape Entrance & Access Picture
MD vs BL & Canals

Upper Central Incisor MD > BL 1 Root Centre of palatal Rounded triangle

1 Canal 100% surface above the
*3 pulp horns cingulum Inverted triangle
(Newly erupted) *Cingulum is strength *Base towards incisal edge
*Rounded DI angle point for this tooth *Apex towards cingulum
*Straight MI angle must preserve
*M longer than D Palatal/Lingual shoulder (shelf of
Bur should be dentine, extends from cingulum
perpendicular on the to 2mm apical to orifice) must
palatal surface be removed:
*Occlusal to the *Prevents direct access to RC
cingulum at 90-degree *Deflects files labially
angle to the palatal *Results in ledge or perforation
surface using GG

Upper Later Incisor MD > BL 1 Root Centre of palatal Rounded triangle or Oval
1 Canal 100% surface above the
Many variations: cingulum *Depending on number of pulp
*Peg shaped: looks horns
like a canine with a *Pulp is smaller with 2 or no
pointed end & no pulp horns
incisal edge *Peg shaped outline will be oval
*Presence of palatal in shape (single horn)
developmental
groove
*Dens invaginatus:
enamel invaginates
through root surface
 Upper Canine MD < BL 1 Root Middle of the lingual Oval
1 Canal 100% surface above the
*Has the longest root cingulum in a
in Maxilla buccolingual direction
*Single or no pulp
horn Bur direction should be
perpendicular to the
lingual surface

Lower Central Incisor Oval

1 Root Centre of palatal
MD < BL 1 Canal 95% surface above the Mandibular incisors:
2 Canals 5% *Most difficult to prepare AC on
cingulum
(Labial & Lingual) *Roots appear flattened
Lower Lateral Incisor *Narrow MD & pulp horns are
close to each other
*Lingual shoulder is not as
prominent as it is in Maxillary
incisors

Lower Canine MD < BL 1 Root Centre of palatal Oval

1 Canal 94% surface above the
*Has the longest root 2 Canals 6% cingulum
in Mandible (Labial & Lingual)
Bur direction should be
perpendicular to the
lingual surface
 PREMOLARS
Tooth Pulp Chamber Number of Roots Entrance Point Access Cavity Shape Entrance & Access Picture
MD vs BL & Canals

Upper First Premolar MD < BL 1, 2, or 3 Roots

(U4) 2 Roots
(Most common)
*2 Cusps (Buccal cusp 1 Canal 26%
is longer than Palatal) 2 Canals 69%
*B= taller pulp horn (Most common; In central groove in the
*P= larger orifice 1 Buccal & middle of an imaginary
*From palatal view 1 Palatal) line connecting the
can see buccal cusp 3 Canals 1% buccal & palatal cusp
*From buccal view; (2 Buccal tips centered MD
mesial slope is longer & 1 Palatal)
than distal slope *Bur should ALWAYS
*From mesial view; be kept perpendicular
Mesial Marginal to the occlusal surface
Developmental *Don’t tilt bur or Oval
Groove, a overextend prep in
continuation from the mesial direction to
Mesial Marginal Ridge avoid perforating
1 Root mesial concavity,
Upper Second MD < BL 1 Canal 75% as the thickness of
Premolar (U5) (Most common) enamel & dentine is
2 Canals 24% less in this area
*2 Cusps of same 3 Canals 1%
height (Buccal &
Palatal) *Has the most
*2 pulp horns (Buccal variations in RC
pulp horn is larger) anatomy & may
*Mesial slope is demonstrate all
shorter than Distal Vertucci’s 8 canal
slope configurations
Lower First Premolar MD < BL 1 Root ½ way up the lingual Oval
(L4) 1 Canal 74% incline of the buccal
(Most common) cusp (to avoid
*Small non-functional 2 Canals 25.5% perforating lingual
lingual cusp 3 Canals 0.5% side) on a line
*Mesial slope is connecting the buccal
shorter than Distal *2 pulp horns cusp tip & lingual
slope (Buccal pulp horn groove between the
*ML developmental is larger than lingual cusps
groove towards MMR Lingual)
on lingual aspect
*Well developed,
large buccal cusp
*DMR is longer &
bigger than MMR

Lower Second MD < BL 1 Root 1/3rd the way up the Oval

Premolar (L5) 1 Canal 97.5% lingual incline of the
(Most common) buccal cusp on a line
*Extreme variation in 2 Canals 2.5% connecting the buccal
anatomy 3 Canals 0% cusp tip & lingual
*Larger than L4 groove between the
*Well-developed Has 2 common lingual cusps
lingual cusp forms:
*From mesial & distal *3 Cusps type
views; crown is less (most common)
lingually inclined than 1 large B cusp
L4 (affects access 2 L cusps (ML > DL)
cavity entry point) *2 Cusps type
1B&1L
 MOLARS
Tooth Pulp Chamber Number of Roots Entrance Point Access Cavity Shape Entrance & Access Picture
MD vs BL & Canals

Upper First Molar MD < BL 3 Roots In the centre of central Trapezoid/Rhomboidal

(U6) 4 Canals groove between the
90% MB2 Canal is line connecting the MB Base is toward Buccal
Largest tooth in Max present (lip of & MP cusp tips and the
arch dentine appears imaginary line (distal Mesial border for access cavity
above it) border) of oblique is MMR, a strength point for
*First tooth to erupt ridge this tooth & should be
in Max arch at age 6- *Curved MB root preserved
7 years (2 canals located in *MB1 canal under MB
MB root) cusp Upper Molars are shifted
*4 major cusps: *Straight DB root *MB2 canal in front of towards Mesial & more Buccally
MB, DB, MP, DP *Large, long MB1 canal (on/just inclined than Distal & not
*MP cusp = largest Palatal root mesial to a line parallel with Lingual wall.
*& 1 small cusp (cusp connecting the MB1 to
of Carabelli) on MP *MB canal orifice P orifice) Pulp chamber & canals are
cusp (sometimes is located under Mesiobuccally shifted
present) MB cusp tip *DB canal is located
*DB canal orifice is mesial to oblique ridge Outline in mesial 2/3rds of the
located slightly & closer to the middle occlusal surface leaving the
distal & palatal to of the tooth than to oblique ridge intact
MB orifice the distal wall
*Palatal canal
orifice is centered *Palatal canal is
palatally longest & largest
centered palatally;
however, it leaves the
pulp chamber as a
round canal & tapers
apically
Upper Second Molar MD < BL 3 Roots Same as U6 with Triangular
(U7) *3 Canals: smaller access opening
MB, DB, Palatal Roots & orifices are closer to
*Smaller replica of U6 each other forming a flat
*4 major cusps: 1 Root 10% triangle
MB, DB, MP, DP 2 Roots 25%
3 Roots 60%
MB1 70%
MB2 30%

*Roots are less

divergent &
sometimes fused

Lower First Molar MD > BL 2 Roots Midpoint on the Trapezoid or Rhomboidal

(L6) 3 Canals: central groove
*2 Mesial between mesial border Access cavity will be located in
*First permanent MB & ML of the access cavity (on the mesial 2/3rds of the tooth
tooth to erupt in oral (MB canal is an imaginary line preserving the distal side
cavity difficult to clean connecting the MB &
because of its ML cusp tips) and
*Most frequent tooth tortuous path) distal border (on an
to require RCT *1 Distal imaginary line
because it’s in the Distal canal is connecting central
oral cavity longest larger groove on buccal side
than any other & lingual groove on
permanent tooth *Sometimes a 3rd lingual side)
mesial canal can
*4 major cusps: be present
MB, DB, MP, DP between the 2
*& 1 small 5th distal mesial canals
cusp (used to differ R (small middle
from L) mesial canal)
Lower Second Molar MD > BL 2 Roots Same as L6 Trapezoid or Rhomboidal
(L7) 3 Canals:
*2 Mesial
*Smaller replica of L6 MB & ML
(Mesial canals
*4 major cusps: tend to fuse in
MB, DB, MP, DP apical 1/3rd )
*1 Distal

*Fused roots will

give a horse shoe
shaped canal in
cross section,
giving rise to C-
shaped canal

*Extra root DL =
Radix Entomolaris

*Extra root DB =
Radix Paramolaris

Objectives of Access Cavities:

1. Smooth, straight-line access to pulp chamber
2. Identification of all canal orifices
3. Conservation of tooth structure

Types of radiographs
1. Pre-operative radiograph (Estimated WL)
2. Working length radiograph (Corrected WL 0.5-1mm less than EWL with file size #15)
3. Master cone fit radiograph
4. Obturation radiograph
Pre-operative radiograph to determine:
1. Root morphology
2. Number of canals
3. Tooth status (fracture, calcification, root resorption, complexity)

Pulp removal is done via 2 aspects:

1. Mechanically by files & Gates Glidden
2. Chemically by irrigation with side vented needle

Biomechanical preparation:
1. K files
2. Irrigation: side vented 27-gauge needle and 5ml syringe and cup with water
a. Wash out any debris that accumulates within the canal during preparation.
b. Irrigation should be carried out between the use of each instrument intended to prepare the canal.
3. Endo ring (ruler)

Standardization of Endo Instruments

- Files come in 3 lengths: 21mm, 25mm, 31mm
- Files are numbered by sizes from 06-140
o Size increases by 2 units from sizes 06-10, by 5 units from 10-60, & by 10 units from 60-140

K-files: stainless steel twisted to form tight spiral

o D0: tip size = file # in 100th of mm
o D1: working blade begins at this tip
o D16: shaft; working plate is always 16mm, but the length may differ (21mm, 25mm, 31mm)
o Working blade begins at D1 & extends to shaft D16
o Taper = 0.02mm per mm of instrument (flute length)
▪ Taper (0.02) = delta D (diameter of the file) / delta L (length needed per mm)
• D= D2-D1 & L= L2-L1
o D16 should be 0.32mm greater than D1
▪ D0= file #
• File # represents diameter of the tip only
▪ D1= file # + 0.02mm
▪ D16= file # + 0.32mm
Files are color coded for ease of recognition

Why You Read Before Going Bed

WHITE YELLOW RED BLUE GREEN BLACK
15 20 25 30 35 40
45 50 55 60 70 80
90 100 110 120 130 140

Working Length Determination (3 ways: apex locator, pre-op radiograph, average tooth length; dental anatomy)
- The maximum length of the root where root canal preparation & irrigation is terminated
- Distance between 2 points: coronal & apical reference points (rubber stopper used to ensure fixed reference point)
o Coronal reference: sound tooth structure (use the nearest cusp tip/incisal edge for reference)
o Apical reference: Minor Apical Constriction
▪ Narrowest part in canal system that provides a good point of termination
▪ We want to confine irrigants & medicaments within the canal
- Objective is to prepare the root canal as close to the apical constriction as possible
- The location of apical constriction normally varies between 0.5 and 2mm from the radiographic apex
- Estimated working length from the pre-operative and intra-operative radiograph
- Taking a working length radiograph with a K-file size 15 to determine EWL.
o Radiographically the file should be 0.5mm – 2mm short of the radiographic apex.
o Based on this radiograph if the distance between the tip of the instrument and the desired working length is >2mm the working
length of the file is adjusted and another radiograph is taken

Initial Apical File (IAF)

- First file that makes contact apically

Master apical file determination (MAF is 2-3 sizes larger than IAF)
- Largest file to reach the full working length
- Insert K-file measured to the working length and make watch winding motion and engage the file in the canal to make a cut in dentine.
- Irrigate
- Then insert K file size 0.5mm bigger to the working length and make watch winding motion
Step back for biomechanical preparation
- Only K-files are used in this technique
- Step back in increments of 1mm as you go up in file size (reaching file size 80) in order to create a taper.
- Recapitulation is important, wherein you use a smaller file in between the step back of files to prevent blockage of the canal and maintain
patency
- Use watch winding motion with all files

For example: if the WL was 20mm and the MAF was 30 you would do as follows:
- MAF 30 WL 20mm
- Irrigate
- File size 35 WL 19mm
- Irrigate then recapitulate with MAF then re-irrigate
- File size 40 WL 18mm
- Irrigate then recapitulate with MAF then re-irrigate
- File size 45 WL 17mm
- Irrigate then recapitulate with MAF then re-irrigate
- File size 50 WL 16mm
- Irrigate then recapitulate with MAF then re-irrigate
- File size 55 WL 15mm
- Irrigate then recapitulate with MAF then re-irrigate
- File size 60 WL 14mm
- Irrigate then recapitulate with MAF then re-irrigate
- File size 70 WL 13mm
- Irrigate then recapitulate with MAF then re-irrigate
- File size 80 WL 12mm
- Irrigate then recheck your MAF making sure it does not go longer than the WL and it should stay firm at the WL.

Ideal Canal Preparation

- Tapered funnel
o Wide coronally & narrow apically
- Facilitates flow of solutions & cleaning
- Reduce stress on instrumentation
- Ease of obturation & good seal
Taper of Canal
- Gradually decreases in canal diameter in a corono-apical direction
- 5% taper
- Decreases 0.05mm in diameter as we move 1mm apically

Endo instruments
- DG-16 (endo explorer) – to locate canal orifices
- Endo access bur for starting access cavity
- Endo Z bur for deroofing
- Gates Glidden for flaring of coronal 1/3rd only of the canal (mostly used with anterior teeth)
- k-files used for manual preparation for canals, come in different diameters and they are color coded.
o There are 3 lengths 21mm, 25mm, 31mm
- Endo plugger used for vertical condensation after obturation
- Hand spreader/finger spreader are used for lateral condensation during obturation of the canal
- Irrigation (washing out via stream of fluid): 27-gauge side vented needle & 5ml syringe

Basic Endodontic Examination Kit

- Front surface mirror: produces a clear & dimensionally accurate single image of the object in view
o Absolute exact image of the object
o Place tip of probe on the surface of the mirror, its tip unites with its image (proper dimensions)
o Allows indirect vision (to view palatal/lingual view)
o Reflects & focuses light onto the surface to be examined
o Used to retract soft tissues, such as cheeks & tongue

- Locking cotton pliers (tweezers)

o Fine tip: hold small items to & from oral cavity
o Allow passage of gripped items between dentist & assistant
o Safety grip: once you click on it, it locks and don’t have to keep pressure on it
 - Periodontal probe
o Check state of tooth with periodontal ligament before root canal treatment
o Measure pocket depths around a tooth in order to establish the state of health of periodontium
▪ Normal depth of periodontal pockets is 2-3mm
▪ > 3mm means patient has periodontal pockets
o It has a flattened end, so it will not damage soft tissues
o They differ in types according to the black bands indicating numerical measurements

Rubber dam kit for tooth isolation

- Sheets
- Frame
- Clamp
- Forceps
- Hole punch

Instruments for Access Cavity Preparation

- Handpieces
- A) High speed (400,000 RPM)
o For cutting enamel (hardest tissue in the body)
- B) Low speed (5,000 – 40,000 RPM)
o For cutting dentine & caries removal (softer)
- Burs
o For caries removal & access
o Classified according to mode of attachment to the handpiece, material (diamond, carbide, or tungsten), and shape (round, straight
fissure, pear, etc.)
- A) Slow Speed – Latch Type
- B) High Speed - Friction Grip
o Endo Access
▪ Round end cutting tapered diamond bur
▪ For starting access cavity
o Endo Z
▪ Safety tip (non-cutting) tapered bur
▪ For deroofing (lateral movement of pulp root)

- Spoon excavator
o Remove coronal pulp & soft carious dentine
o Remove (curettage) of pulp chamber (soft tissue)

- DG-16 (16mm; Endo Explorer)

o Has 2-pointed & tapered sharp working ends angled at 45 & 70 degrees
o To locate root canal orifices in all teeth
o Check smoothness & uniformity of access cavity
o Since it has a sharp end, we can’t use it on soft tissue
o Side note: orifice is the meeting point of canal with roots after pulp chamber (pulp chamber > canal > root)
Instruments for Mechanical Root Canal Preparation
- Mechanical means physical changes in the shape of root canal
- Endo Ruler/Ring
o Used to measure the length of files, gutta percha, and paper points
o Ruler is more accurate than ring (measurement is in mm)
- Endo file organizer
o Store & organize files
- Endo files
o For mechanical preparation of root canals
o 2 types:
▪ Stainless Steel Hand files (16mm fixed WL)
▪ Nickel Titanium Engine drive rotary files

Gates Glidden Drills

o Flame shaped engine driven side cutting instruments with safety tips
o Latch-type (slow handpiece)
o Available in a set from sizes 1 to 6 represented by the number of bands with diameters from 0.5 to 1.5mm
o Use in brushing strokes (do not apply pressure in vertical motion)
o Safety design of GG is that its weakest part lies at the junction between shank & shaft, such that fracture always occurs at the base
of the shaft not at the tip making for easy removal from the canal.
o Used for coronal flaring in anterior teeth only as canals in posterior teeth are smaller and can perforate
o Used during retreatment cases for removal of gutta percha
o Used for post space preparation
o Used to widen the canal when an instrument has fractured in it
Smear Layer
- Layer of debris comprised of dentine, pulp tissue remnants, & microorganisms covering the canal walls
- Organic part: pulp remnants & microorganisms
o Removed by sodium hypochlorite
- Inorganic part: dentine debris
o Dissolved by citric acid or EDTA (chelating agents that bind with calcium & dissolve calcified tissue)